introduction to infant nutrition. framework – growth and assessment – nutrient needs – formula...
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Introduction to Infant Nutrition
Framework– Growth and Assessment– Nutrient needs– Formula and Breast milk– Feeding development and relationship– Non milk feedings
Population v.s. individual
Goals and Objectives
Optimal growth and development Individual health Population Health Prevention and Chronic Illness
Population vs individual
AAP Guidelines DRI’s Bright Futures Start Healthy Feeding
Guidelines
Needs Guidelines Recommendations education
Recommendations/guidelines
DRI: Dietary Reference Intakes– AI– UL– EER
AAP Bright Futures Start Healthy feeding guidelines
DRI: Dietary Reference Intakes
– periodically revised recommendations (or guidelines) of the National Academy of Sciences
– quantitative estimates of nutrient intakes for planning and assessing diets for healthy people
AI: Adequate Intake UL: Tolerable Upper
Intake Level EER: Estimated Energy
Requirement
Infant Feeding Practices Study II
Fein, Sara B. et al Pediatrics Vol 122 October 2008 (Supplement)
– Data from nationally distributed consumer opinion panel of 500000 households
– Mothers of healthy term and late preterm infants– N= 4902 pregnant women, ~2000 continued
through infants first year
Infant Feeding Practices Study II
83% of survey respondents initiated breastfeeding
Declined to 50% at 6 months and 24% at 12 months
52% of breastfed infants received some formula in the hospital
40% received infant cereal at 4 months
Infant Feeding Practices Study II
Majority of formula feeding mothers did not receive instruction on formula preparation or storage from a health professional (73-77%)
30% did not read safe use instrcutions on package label
55% did not wash hands before bottle prep, 32% did not wash bottle nipples between use, 35% heated bottles in microwave, and 6% did not always discard formula left standing > 2 hours
Infant Feeding Practices Study II
At 6 months of age 18% of term breastfed and mixed fed infants had not received infant cereal or meat in the previous 7 days. 58% received <2 daily servings and did not receive oral supplements >3X per week
Screening, Assessment, Education
Information Collected
Growth Dietary Medical history Diagnosis Feeding and developmental information Psychosocial and environmental information Clinical information and appearance (hair, skin, nails, eyes) Other (anthropometrics, laboratory)
Nutrition Screening: Purpose
To identify individuals who appear to have or be at risk for nutrition problems
To identify individuals who require further assessment or evaluation
Identify risk and education needs for prevention of nutritional problems
Screening: Definition
Process of identifying characteristics known to be associated with nutrition problems
– ASPEN, Nutri in Clin Practice 1996 (5):217-228
Simplest level of nutritional care (level 1)
– Baer et al, J Am Diet Assoc 1997 (10) S2:107-115
Assessment
Screening identifies nutritional risk Nutrition Assessment
– Uses information gathered in screening– Adds more in depth, comprehensive data– Interprets data– Develops care plan– Reassess
Goals of Nutrition Assessment
To collect information necessary to document adequacy of nutritional status, identify deficits, and determine etiology of any identifiable problems
To develop a nutritional care plan that is realistic and within family context
To establish an appropriate plan for monitoring and/or reassessment
Assessment Process
Linking information collected with:
– Goals/expectations– Reference data/standards– Evidence– individual
Asking questions
CDC Growth Charts: Tool for Screening and Assessment
Standardized data collection methods Expanded sample Exclusions
– VLBW infants– NHANES III weight data for >6 year olds
Challenges
Challenges
Information– Availability, sufficiency,
accuracy
Interpretation– Goals, expectation,
“does it make sense”
Questions– What are goals and
expectations, “does it make sense”
Challenges
Nutrient needs influenced by:
genetics, activity, body composition, medical conditions and medications
Individuals anthropometric date influenced by:
genetics, body composition, development, history
Considerations Growth in infancy Physiology of infancy
GI Renal
Infant Development Nutrient requirements
* Recommendations Milk based feedings/Infant formulas Timing of complementary foods
– What are families actually doing? Specific issues of safety and oral health
Challenges: Recommendations for populations v.s individual
Challenges
Identification of etiology Weighing risk vs benefit Supportive of:
– Family– Individual– Development/temperament
Assessment Process
Linking information collected with:
– Goals/expectations– Reference data/standards– Evidence– individual
Asking questions
Interpretation
Linking information collected with:
– Goals/expectations– Reference data/standards– Evidence– individual
Asking questions
Interpretation: Asking Questions
Is there a problem?
Was there a problem?
Does information make sense?
What are goals and expectations?
What is etiology of the problem?
Contributing Factors
Inadequate IntakeFluid, energy
MedicalBPD, reflux, frequent illness
Feeding relationshipStress, history
Psychosocial
Joey
Adam
Adam
Adam
Intervention
Identify etiology Identify contributing
factors Support feeding
relationship Consider psychosocial
factors, family choice and input
Weigh risk v.s. benefit
Weighing Risks and Benefits
Intervention
Adequate intake vs feeding relationship
Concentrating formula vs fluid status
Impact on tolerance, compliance, errors, cost
Solution to problem vs. exacerbating problem
Examples
Common Recommendations
Breastfeed to at least 1 year Iron fortified cereal by 4-6 months Vitamin D Supplementation Introduce 1 food at a time
Screening Risks
Weight less than 5th %ile Weight greater than 90th %ile Improper or inappropriate food/formula
choices or preparation Bottle in bed
Jamie
6 months of age Family hx of allergies Mom discontinued breastfeeding when
returned to work at 5 months
Toby
11 months old FTT Receives formula in bottle. Difficulties with
bottle feeding. Likes solids. Takes few jars of stage III fruits, vegetables, dinners per day
Advised to avoid milk until baby over 12 months of age (excluded milk, cheese, yogurt, butter)
Mattie
10 month old “colicky, irritable” Young mother, lives in small apartment, “thin
walls” neighbors complain about noise Baby has 10-12 bottles per day of formula, or
juice. Has bottle in bed at nap and night Weight at 75th %ile, length and 75th %ile
Zoe
8 months old Exclusive breastfeeding Weight and length at 50th %ile. Hct within normal limits Mom believes breast milk provides all
nutrients and offering anything else will result in infant discontinuing or “weaning” from breast